Amputation Decision Aid launch!   Dear colleagues, We’re very excited to reconnect as we launch the Amputation Decision Aid website. The website includes a collection of freely available resources to help people make more informed decisions about partial foot amputation due to peripheral arterial disease. At some point during the research and development phase, we’ve personally connected with well over 100 different people. Some of you will have reached out following a conference, or expressed interest in using these resources in clinical practice. Others will have participated in the expert panels that helped guide this work. Your support and encouragement has been motivating, and a reminder of the need for the resources we’ve developed. “We want to fundamentally change the way decisions are made about amputation surgery. We want to ensure people have access to meaningful conversations with a healthcare provider; conversations that include accurate and unbiased information about their treatment options, the likely outcomes, as well as the risks. We want to see people supported as they deliberate on such a difficult decision. Only then can people make truly informed decisions about amputation surgery.” – Associate Professor Michael Dillon, La Trobe University.   We are so pleased to reconnect during this launch of the Amputation Decision Aid, and to encourage you to explore the website and make use of the shared decision-making resources including the: ·    Amputation Decision Aid - specifically written for people facing the prospect of partial foot amputation due to peripheral arterial disease. It includes unbiased information about the different options, the likely outcomes, and risks of complications in simple terms that are easily understood. ·    Amputation Discussion Guide – a companion resources for healthcare professionals that includes up-to-date research evidence and example conversation starters to facilitate meaningful conversations tailored to the needs of each individual patient. ·    Training videos – a series of five, short, animated videos to help healthcare providers learn more about shared decision-making, and how to use our resources in clinical practice.   Given your interest and support over time, we would be grateful if you would: ·    Read our launch information on LinkedIn. Please like, comment, and share the article with your colleagues ·    Check out our website to learn more ·    Promote the website and its resources through your professional networks ·    Follow us on Twitter to stay up-to-date with our work. Please like, comment, or retweet our posts If you’d like further information, please do not hesitate to contact us. We’d love to hear from you. We would like to take this chance to acknowledge and thank our partners; in particular the generous financial support provided by the American Orthotic Prosthetic Association. In closing, we wanted to again say thank you for your interest and engagement during the development of these shared decision-making resources. We hope you find the resources valuable. In due course, we would love to hear about your experience using them, and how we might make them better in the years ahead. Regards, Michael Dr. Michael Dillon, PhD. on behalf of the developers.

 

Rural nsw podiatry opportunity

A unique full time opportunity exists for a Podiatrist to join a dynamic team based at Tamworth to gain experience in High risk foot and generalist podiatry. 

Employment Type: Temporary Full Time until 30th June 2022

Position Classification: Podiatrist Level 1 / 2

Remuneration: $64.463 - $93,393 per annum
Hours Per Week: 38
Requisition ID: REQ240413

Applications Close: 6th July 2021

Follow the link to apply: https://jobs.health.nsw.gov.au/hnelhd/jobs/podiatrist-level-1-2-108512?et=2bMiH1lnh 

QLD/DD2104369661 - Senior Podiatrist HP4

Closing date of 11.59pm on 5th May 2021

https://smartjobs.qld.gov.au/jobs/QLD-DD2104369661

Hunter New England LHD is advertising for a Podiatry Level 1/2 at 1.0 FTE. 

REQ218852 - Podiatrist Level 1 / 2 

Closing date of 11:59pm on 6^th April 2021.

https://jobs.health.nsw.gov.au/hnelhd (HNE Health Career Portal)

https://healthnswgov.referrals.selectminds.com/ (NSW Health Career Portal)

https://iworkfor.nsw.gov.au/ ( I work for NSW website)

It will also appear on Facebook on 29 March 2021.

Watch this space for virtual and state-based educational and networking opportunities!

Launch of national Integrated Diabetes foot care pathway (australia)

The NDSS FootForward initiative launched a new diabetes foot risk stratification tool at the 2020 Australian Diabetes Congress.

Diabetes foot risk stratification and triage

A Risk Stratification Pathway categorises people with diabetes into four risk categories (very low, low, moderate and high) and provides a definition of each category. These are linked to actions which provide a guide to services or interventions the person with diabetes should receive and who should deliver that care.

Active foot disease pathway

The Active Foot Disease Pathway classifies the main categories of active foot disease that can affect people with diabetes and provides a definition of each category. As with the stratification pathway, it is linked to actions, services and guidance on who is best placed to deliver the required care.

LEAP 2020 – Call For Abstracts

Lightning Presentations – Lower Extremity Amputation Prevention (LEAP) Conference 2020

Conference Theme – Staying in Step: Evidence to practice change.

The Scientific Committee invites submissions of abstracts of original research in the area of the high risk foot.  We are seeking presentations on areas that have a strong clinical application, and impact on clinical practice in the assessment, diagnosis and management of the high risk foot that can support clinicians to provide best practice care, and to empower and support their clients. Lightning talks are concise oral presentations of 3 minutes duration, requiring the speaker to focus on the key points of their research.

Abstracts are due no later than 5.00pm AEST, Friday 17^th April 2020

Successful applicants will be notified by Monday 1^st June 2020

Selection of abstracts for the Scientific Program will be made by the conference committee

Abstract Submission Guidelines:

Authors and affiliations: Authors (Arial, size 12 font. Surname, Initial. Presenting author to be in bold and italics. Affiliations number in superscript. Centred) eg Smith, B¹, Doe, J²; Affiliations: (Arial, size 12, Italics font. Organisation, City, Country) eg ¹ Department of General Practice, University of Melbourne, Parkville, Australia

Title (max 50 words): The title should be as brief as possible while still conveying the topic and nature of the research

Abstract body (max 250 words)

To include the headings: Background and aims; Methods; Results and Conclusions

Before writing your abstract: Consider the following:

• How to introduce your work (what is the background/rationale for the research?)
• What data to include in order to answer the research question
• How the data is best presented
• What conclusions you can draw from the results and who they apply to
• How you can link your research outcomes and conclusions to clinical practice

All presenters must be registered to attend the conference. Abstract acceptance will be subject to registration for the conference.  Please remember that submitting an abstract does NOT automatically register as a conference delegate.  Conference registration can be completed online at a later date.

Please email your submission app-hrf@ozemail.com.au no later than 5:00pm AEST, Friday 17^th April 2020.

The APP-HRFG committee has submitted the following recommendations to the MBS Review Taskforce to be considered for plans to modify the MBS in relation to high risk foot services:

5.1.1 Recommendation 1

• We question the rationale of the age requirement of patients at risk of developing a chronic wound being over 75 years; we recommend that the committee consider no age restrictions in patients with comorbidities or any known diabetes complication. As cited in the rationale/reference to recommendation 1 (page 32) people 65 years and older account for 85% of non-healing wounds in the USA. An age restriction on access to a chronic wound review may delay referral to an appropriate service and expert care.

 5.1.3 Recommendation 2:

Referral to a specialist may be necessary if the following is occurring:

• We suggest an amendment in replacing the current ABPI cut-off of 0.5 and changing the language to be in line with the evidence presented in the International Working Group of the Diabetic Foot (IWGDF) guidelines 2019.
• The review must include toe pressures or TcPO₂ readings as indicators of peripheral artery disease – instead of ABPI – in line with IWGDF guidelines, as ABPIs are known to be inaccurate (falsely elevated) in people with diabetes and chronic kidney disease due to Monckberg’s calcification. This reflects the best current evidence available.

 5.1.9 Recommendation 5:

• Allied health services (podiatry in particular) should have specified item numbers for neuro/vascular assessment, wound debridement and specific offloading interventions and not just an increase in number of visits. Funding appropriate assessment will improve treatment planning and longer-term care. An increase in number of services without demonstrated requirements of evidence-based assessments and interventions may be subject to misuse.
• Appropriate evidence of documentation and additional communication with the patient’s treating team is required, consistent with current requirements for correspondence under TCAs.

 5.1.11 Recommendation 6:

• We suggest incorporating existing referral guidelines including those from the Foot Forward project for consistency and to assist GPs in decision-making for timely onward referrals. The IWGDF and the Foot Forward project have compiled the evidence base for interventions that aid the management of the diabetic foot; and Diabetic Foot Australia have published local guidelines for offloading diabetic foot wounds which are known cornerstones in diabetic foot wound management. There is sufficient evidence for cost effectiveness of offloading to be standard care as part of chronic wound management on the foot.

 6. Education, credentialing and accreditation

• We suggest that it should be mandatory for allied health practitioners working in private practice to be able to claim specific item numbers – should additional requirements for credentialing or evidence of experience or expertise in advanced wound care be required, it is imperative that this is done through AHPRA and not membership-based organisations.

 6.1.9 Recommendation 20:

• Allied health and nurse practitioner services should also meet similar requirements to access subsidised wound consumables. Failure to do so will place further burden on patients who will be required to travel from their podiatrist to their GP for a dressing change following a podiatric debridement of a diabetic foot ulceration.

 6.1.13 Recommendation 22:

• AHPRA is the only appropriate organisation to manage and monitor accreditation. If this requirement is to be taken on by another body, there would be duplication, and a further level of bureaucracy. There would be a delay in establishing the credentialing process and which organisations could undertake such credentialing. Wound/Ulcer management is a core podiatry competency.

 7.2.1 Recommendation 24: Development of a wound consumables scheme:

• As highlighted in our response to Recommendation 6, there is strong evidence for the cost effectiveness of offloading modalities in the healing and prevention of chronic foot wounds. Funding streams are currently inadequate, resulting in poor outcomes for people at risk of or living with these wounds. For example, in Victoria an approved State-Wide Equipment Program (SWEP) application can take 6 months before funding is available, and the Tasmanian Southern Footwear Scheme has similar wait times. The NDIS is only available to patients under 65 so a significant proportion of individuals with chronic foot wounds have inadequate access to footwear or offloading modalities.
• As such, we suggest the inclusion of medical grade footwear and offloading modalities such as a CAM Walker or Total Contact Cast as part of the scheme.

We also ask that members of the taskforce consider the following recommendations:

• Include podiatrists, in addition to general practitioners and nurses, as professionals trained and credentialed to access MBS wound care item numbers. Assessment, prevention and management of chronic foot wounds are part of podiatry core competencies and podiatrists are acknowledged to play a crucial role in this field. Podiatrists should also be subject to education and training requirements to ensure those who claim in primary care are equipped to do so safely.
• The mandated referral to a ‘specialist wound care practitioner’ should refer specifically to local High Risk Foot Services for treatment of chronic foot wounds. The national, federally funded Foot Forward project is currently defining a national referral pathway to minimise delays in referring individuals with diabetic foot wounds to tertiary, multidisciplinary services where highest levels of evidence-based care are provided.
  

Links/References

ANZPAC Podiatry competencies: http://www.anzpac.org.au/files/Podiatry%20Competency%20Standards%20for%20Australia%20and%20New%20Zealand%20V1.1%20211212%20(Final).pdf

International Guidelines for the prevention and management of diabetic foot disease (2019): https://iwgdfguidelines.org/

Foot Forward project (National Association of Diabetes Centres): https://nadc.net.au/foot-forward/

The MBS review into wound management has been released - please see the following link from the wound management working group: 

MBS Review

As there are a number of areas of concern regarding HRF, the APP-HRF committee will be providing a submission to the taskforce. We welcome all members to send us your feedback by COB 10th January 2020.